Colonoscopic excision of large and giant colorectal polyps

Abstract

Large polyps are sessile or pedunculated lesions that are larger than or equal to 3 cm in size. Sixty-six colonoscopic piecemeal excisions of large pedunculated and sessile polyps (75 percent of 88 recognized large polyps) were performed over eight years. The macroscopic feature of the lesions and the result of an extensive snare biopsy were the deciding factors for endoscopic as opposed to surgical removal. Only three complications (4.5 percent) were recorded (two hemorrhages and one colonic wall burn syndrome), none of which required surgery. Fifty patients with 52 adenomatous lesions had colonoscopic follow-up (range, 3 to 85 months). Of 36 sessile adenomas, two cases of residual (5.5 percent) and four of recurrent disease (11 percent) were observed. Colonoscopic removal is an alternative to local surgical excision of large benign colorectal polyps, and often can be an alternative method to elective colectomy in elderly and high-risk patients.

New indication for endoscopic treatment of colorectal carcinoma with submucosal invasion

“…Colorectal carcinoma (CRC) is one of the most common cancers in developed countries. Increasing numbers of early stage CRC and precancerous adenomatous lesions, not only polypoid type lesions but also flat and depressed type lesions, can be discovered and treated under endoscopy thanks to endoscopic ultrasonography, high magnification chromoendoscopy, and other technical advances 1–12 . Therefore, it is becoming more important to understand the correct indications and limitations of endoscopic tumorectomy.…”

Transanal endoscopic microsurgery in large, sessile adenomas of the rectum

“…Only a few studies (with a smaller number of patients) have evaluated the management and histological features of large, sessile adenomas of the rectum [2,3,33,35]. The rarity of these adenomas means that individual surgeons, pathologists, and especially physicians of other departments are unlikely to gain wide experience on this topic.…”

Endoscopic polypectomy: techniques, complications and follow-up

“…Although there have been no studies on the visual criteria of malignancy in a polyp, the Hamburg group [9] states that a benign polyp (of any size) does not have any of the following features: ulceration, induration or friability. Kanamori et al [8] reported that large flat polyps were generally benign, and that all the invasive carcinomas that were encountered were in elevated sessile polyps. Is it worthwhile to biopsy a benign-appearing polyp and then decide whether it actually contains cancer before proceeding with polypectomy?…”

“…In a large tertiary referral centre in Hamburg, Germany [9], an average of 16 polyps over 3 cm in diameter were endoscopically removed annually. Another study on large polyps from Japan [8] showed an average of 10 endoscopic resections annually. When large polyps are identified endoscopically, several decisions must be made, including: Is it benign or malignant?…”

“…Transection in a single piece is generally feasible even for large polyps with a diameter within 2 or 3 cm [7,8]. After grasping, the polyp is lifted or tented into the lumen in order to create an artificial stalk.…”